Take a look at this gal.
Why does she have a cross over gait?
note how much tibial varum she has (curvature of the tibial in the coronal plane)
how much adduction of the right foot there is, potentially indicating a tight posterior compartment, or p…

Take a look at this gal.

Why does she have a cross over gait?

  • note how much tibial varum she has (curvature of the tibial in the coronal plane)
  • how much adduction of the right foot there is, potentially indicating a tight posterior compartment, or perhaps a loss of internal rotation of the right thigh
  • the excessive posterior rotation of the left shoulder and upper body
  • the subtle abduction of the right arm compared to the left
  • the slight torso lean to the left

The correct answer is we don’t know until we examine her. Maybe is is there out of necessity or perhaps it is a more efficient running style for her. Here are some points:

Technical Issues with the crossover gait

The cross over gait may be:

  • a more efficient running style
  • a potential pathologic musculoskeletal motor pattern
  • better for long distance runners
  • a challenge to balance because of a narrower base of support

It may also be related to:

  • a weak gluteus medius
  • weak adductors
  • excessive foot pronation
  • lower extremity morpholgy (like tibial varum, forefoot varus)
  • a weak vastus medialis
  • a weak tibialis posterior
  • and the list goes on

Join us, tomorrow, Wednesday evening, 8pm EST, 7 CST, 6 MST, 5PCT for an hour of crossover gait on chirocredit.com or onlinece.com for Biomechanics 316. We look forward to seeing you there..

The Gait Guys: Shawn and Ivo

Podcast 51: Bouncy Gait, Stem Cells & Plantar fasciitis,

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-51-bouncy-gait-stem-cells-plantar-fasciitis

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience:

1. Stem cells and plantar fasciitis.
2. Study finds axon regeneration after Schwann cell graft to injured spinal cord
http://www.medicalnewstoday.com/releases/270623.php
3.Future Tiny Robots Will Communicate Using Only Molecules
http://www.fastcoexist.com/3020657/futurist-forum/future-tiny-robots-will-communicate-using-only-molecules?partner=rss
Correction:
a. I was listening to pod 49, great job. I am sending a personal message to point out an error regarding body composition. Under water weighing is considered the 2 compartment “Gold Standard” however caliper testing is used more due to cost and ability to be used in the field. Loved the learning stuff I sent some stuff similar to what you were talking about to the school administration but it went no where.
Thanks guys, Mark
b. Mark wrote: “I can see widening base of support to increase stability when one is weak but to widen base of support when one has decreased traction may increase slipping depending on width of stance couldn’t it. If decreased traction is a issue wouldn’t a better statagy”
Blog reader:
Not very infrequently the foot tripod has been discussed. Especially the importance of the medial tripod (MT) has been of great benefit to me. Some kind of a peroneus paralysis was probably the cause of weak MT of the right foot. With a weak anterior muscle group or compartment. But what about the lateral tripod, ie the 5th distal end of the fifth metatarsal. Which muscles are most responsible for the foot stability here and what kind of exercises might be of therapeutic value? Thank you.

Disclaimer
Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204 

Dear Gait Guys,                                
I’ve had a problem for a while where my lower left leg whips across the midline of my body at the start of the swing phase. This happens immediately after my left foot leaves the ground and before my right foot makes contact. My left knee seems to be angled outward, and I think this is due to some sort of external rotation of the hip or femur during the the early part of my swing phase. I attached a picture to illustrate this problem in my gait. I recently came across a blog post you guys wrote (http://thegaitguys.tumblr.com/post/14262793786/gait-problem-the-solitary-externally-rotated) and under the possibilities as to why there isn’t enough internal rotation, the second option describes exactly what happens when I run. So my question is, what can be done to correct this improper gait pattern? Thank you very much for taking the time to read this.
Sincerely,
Matthew
Between a quarter and a third of everything on the web is copied from somewhere else

 

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So you want to do a Gait Analysis: Part 2

This is the second in a multi part series. If you missed part 1, click here.

We have been exploring the gait cycle, one step (literally) at a time. A quick review of the walking gait cycle components:

There are two phases of gait: stance and swing

Stance consists of:

  • Initial contact
  • Loading response
  • Midstance
  • Terminal stance
  • Pre-swing

Swing phase:

  • initial (early) swing
  • mid swing
  • terminal (late) swing

today, lets explore Loading Response

we remember that Loading response occurs when there is eight bearing on the loaded extremity from initial contact. This continues until the opposite foot is lifted for swing.

Lets look at what is happening here at the major anatomical areas:

Foot

  • Pronation begins: This is when the proverbial “rubber hits the road” occurs. Hopefully the coefficient of friction of the heel with the ground is great enough that pronation of the midfoot begins. As the calcaneus slows, the talus slides anteriorly and plantar flexes, adducts and everts, unlocking the subtalar joint and (hopefully) moving toward making its axis parallel with the calcaneo cuboid joint at midstance (more of that next time).
  • because of this motion, the calcaneus everts approximately 5°
  • both of these motions serve to lower the center of gravity of the leg, deepening the ankle mortise to provide more stability to the ankle
  • Both of these motions (especially adduction of the talus) initiate internal rotation of tibia and lower leg
  • these actions are attenuated by eccentric action of both the long flexors and extensors of the ankle, as well as the foot intrinsics

Ankle

  • The ankle plantar flexes 5-10 °. This motion is attenuated by eccentric action of the anterior compartment muscles of the lower leg
  • this serves to absorb shock (remember pronation is a shock absorber? if not, see here)
  • Ankle rocker occurs (click here for a review of the rockers of the foot)

Knee

  • Flexion to 20°. This is attenuated largely by the quadriceps, contracting eccentrically

Hip

  • The hip is at full flexion at loading response and now begins to extend. This is facilitated by a brief contraction of the gluteus maximus (which started at initial contact)

Starting to see what is happening? Can you understand why you need to know what is going on at each phase to be able to identify problems?

We are The Gait Guys. Two geeks spreading the word. WE appreciate your help doing the same.

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So you want to do a gait analysis? Part 1

From casual observation to a computer driven model, before you can know what may be wrong with a gait, you need to know what is right. Knowing what is happening at each phase of the gait cycle is essential. This series will explore just that and provide you with an overview of what should be happening.

Let’s begin with a typical walking gait cycle. There are two phases: stance and swing. It comprises approximately 62 percent of the gait cycle.1 Jaqueline Perry2,3 uses this descriptive classification to describe stance phase:

  • Initial contact: When the foot first touches the floor.
  • Loading response: Weight bearing on the loaded extremity from initial contact and continues until the opposite foot is lifted for swing.
  • Midstance: The first half of single-limb support, beginning when the opposite foot is lifted until weight is over the forefoot.
  • Terminal stance: Begins with heel rise and continues until the opposite foot strikes the ground.
  • Pre-swing: When initial contact of the opposite extremity begins and toe-off ends.

Swing phase is divided into 3 parts

  • initial (early) swing: when the extremity is being accelerated just after pre swing; this action initiates supination in the opposite, stance phase leg
  • mid swing: largely passive
  • terminal (late) swing: when the extremity is being actively decelerated, largely through eccentric action of the muscles

How about we start with initial contact, commonly called “heel strike”.

Heel strike, a traumatic deceleration event with the transfer of weight from one extremity to the other, creates shock, which must be attenuated. This is accomplished by four distinct mechanisms:

  • Ankle plantar flexion: At heel strike, followed by eccentric contraction of the pretibial muscles to decelerate foot fall.
  • Subtalar pronation: As the coefficient of friction between the calcaneus and the ground increases, the talus slides anterior on the calcaneus while plantar flexing, adducting and everting. This motion causes concomitant internal rotation of the lower leg. Both these actions cause a time delay, allowing force to be absorbed over a longer period of time.
  • Knee flexion: This is a reaction to the heel rocker, forward motion of the tibia, and passive tension in the posterior compartment. It is slowed by eccentric contraction of the quadriceps, with the abdominals acting as a primary anchor.
  • Contralateral pelvic drop: This is decelerated by the ipsilateral hip abductors (primarily gluteus medius) and lateral chain, as defined by Myers.4 It occurs as weight is suddenly dropped on the contralateral limb.

What is happening biomechanically? Lets look at the major anatomical areas:

  •  Foot

the foot should be supinated at this point, as it should be from preswing. It is dorsiflexed, inverted and adducted. 

  • Ankle

The ankle should be neutral or slightly dorsiflexed

  • Knee

the knee is usually neutral or slightly flexed and the thigh and leg externally rotated approximately 4-6 degrees

  • Hip

The heel strike hip should be flexed 20-30° and the lumbar spine neutral; the opposite hip should be extended 20-30° and equal to the amount of flexion present in the initial contact hip.

Today, look for aberrances at initial contact in your clients and patients. Knowing what is normal is the 1st step toward knowing what isn’t. Got it?

Next post in this series (not necessarily our next post) will cover loading response.

Ivo and Shawn

 

  1. Root MC, Orion WP, Weed JH. Normal and Abnormal Function of the Foot. Los Angeles: Clinical Biomechanics, 1977.
  2. Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, NJ: Slack 1992.
  3. The Pathokinesiology Service and the Physical Therapy Department. Observational Gait Analysis. Rancho Los Amigos National Rehabilitation Center, Downey, CA, 2001.
  4. Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Elsevier: 2001.

Singer Songwriter Jewel and her knee hyperextension.
One of our favorite television shows is “Alaska: The Last Frontier”.  What some of you might not know is that the show is about Singer Songwriter Jewel’s family, the Kilchers. Ye…

Singer Songwriter Jewel and her knee hyperextension.

One of our favorite television shows is “Alaska: The Last Frontier”.  What some of you might not know is that the show is about Singer Songwriter Jewel’s family, the Kilchers. Yes, Her name is Jewel Kilcher.  The theme to the show is written and sung by Jewel and her father Atz Kilcher.  The Kilcher’s are tough folk who live off the grid (mostly) and maintain a subsistence living off the land in Alaska.  

Use the photo above to help you clearly understand what we are talking about in this video here (link)  where we see Jewel and her dad getting ready to sing the show’s theme. In this video, Jewel is in some insanely high heeled shoes and being the gait geeks that we are we could not help but notice the degree of knee hyperextension she was displaying.  

What can we extrapolate from this genu recurvatum / hyper extension knee posturing  ?:

We are going to keep it to things from pelvis down or we will be here all day.

  1. Anterior pelvis tilt. She appears to be sitting back into her pelvis so to speak, doing so we can see an increased lumbar lordosis pressing the pelvis anterior.  In many cases combine this with suspect weak lower abdominals and the pelvis drops in the front. This position is often met with isometric contraction of the gluteals helping to maintain the forward/anterior shifted pelvis.
  2. The above, will create an abnormal (possibly increased) tensile load on the hamstrings since the ischeal tuberosities are being drawn cephalad (up). This can create a net posterior shift of the knee joint since she is in relative hip extension, the pelvis is often also translated forward into the sagittal plane pushing the head of the femur into anterior glide into the front of the acetabulum.
  3. The knees are often locked into hyperextension. This will create meniscal tensions and certainly cause increased patellofemoral pressures.  This can also create the rarely diagnosed, but often present, anteriormeniscofemoral impingement syndrome. In this type of presentation the anterior compressive forces are so great compared to what should be balanced forces around the entire joint that the superior leading edge of the anterior mensicus (can affect medial or lateral menisci) begins to become impinged and irritated as the femur rolls and translates too far anterior. You have to know it exists to make the diagnosis.
  4. She will be in ankle plantarflexion because of the footwear instead of balancing the tibia neutrally over the talus.  The tibia will rest on the posterior talus. If constant, the plantarflexion means shorter posterior compartment (gastroc-soleus) and usually weak anterior compartment (tibialis anterior and long extensors of toes).  If she is a runner we bet shin splints were on her holiday list of things to resolve. 

These are just the sagittal plane flaws we can assume. There are more but this is plenty to think about right now. 

Remember, these are just assumptions. Like in video analysis, anything you pic up on film is just a compensation. It does not tell you what you have wrong until you can test them for neuromuscular integrity and motor pattern assessments.  Do not hang your hat on photos or video analysis. Do the extra work that is required.  After all, you know where ASSUMPTIONS get us.

The Gait Guys.

Shawn and Ivo

Podcast 50: Lactate Thresholds, Fartleks ? & more.

A. Link to our server:

http://thegaitguys.libsyn.com/pod-50

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience
1. Yes, this is dog: No More Woof aims to translate canine thoughts into human speech
http://www.engadget.com/2013/12/18/no-more-woof-indiegogo-concept-dog-headset/
2. Foot Drop solution ?
4. Gait Talk:
4B . Lactate Threshold Talk
5. Footprints of the gait gods.
6. Fascial NeuroBiology: An explanation for possible manual therapy treatment effects «
http://www.thebodymechanic.ca/2012/10/28/fascial-neurobiology-an-explanation-for-possible-manual-therapy-treatment-effects/
7. National Shoe Fit Certification Program
8. Email:

Hi Guys -
I’m based in the UK. I’ve been running again for a year. I upped to 35 miles per week a month ago (from 25/30) and two weeks later I was injured with an inflamed piriformis muscle (it’s not syndrome). The pain is on my left side. I have a weaker gluteus medius on my left side. I did also put a chainsaw through my right inner thigh near the knee (it fell short of the bone and main artery in the leg) when i was 18 (i am now 40) - which may also have something to do with my question, but maybe not.
When I run, my right foot points outward during my right foot’s swing phase (but it lands straight). I can’t find an answer anywhere: is my outward pointing right foot perhaps the cause of the piriformis inflammation, and if so, how do i correct my foot movement during the swing phase? Help!!!
Weirdly, i have been obsessing about it for months but cannot correct it, and because of that I’ve noticed that a number of other people have from the same problem.

* Disclaimer
10 . How Does Foam Rolling Work? And Why “SMR” Should be Called “SMT” | Bret Contreras
http://bretcontreras.com/how-does-foam-rolling-work-and-why-smr-should-be-called-smt/

11. Behold The ‘Strength Axle’

Orthotics and Foot beds, What’s the Difference?

Welcome to rewind Friday Folks. Here is an oldie but a goodie, with lots of great information. Rememeber; if you use or prescribe orthotics, hopefully you are using exercises as well and hopefully, th…

Orthotics and Foot beds, What’s the Difference?

Welcome to rewind Friday Folks. Here is an oldie but a goodie, with lots of great information. Rememeber; if you use or prescribe orthotics, hopefully you are using exercises as well and hopefully, the prescription is changing over time and you are removing correction from the device!

Orthotics and footbeds, they’re the same thing, right? This is a question that is often posed to us.  No, they’re not the same, but oftentimes one or the other can be appropriate. To explain the difference, we need to understand a little bit about foot mechanics.

The foot is a biomechanical marvel.  It is composed of 26 bones and 31 articulations or joints.  The bones and joints work together in concert to propel us through the earth’s gravitational field.  It is a dynamic structure that is constantly moving and changing with its environment, whether it is in or out of footwear.  Problems with the bones or joints of the foot, or the forces that pass through them, can interfere with this symbiosis and create problems which we call diagnoses.  They can range from bunions, plantar fasciitis, shin splints, TFL syndrome, abnormal patellar tracking, and lower back pain just to name a few.

Before we go any further, we should talk a little bit about gait (ie walking pattern). Normal walking can be divided into 2 phases, stance and swing. Stance is the time that your foot is in contact with the ground. This is when problems usually occur. Swing is the time the opposite, non weight bearing foot is in the air.

 

The bones of the foot go through a series of movements while we are in stance phase called pronation and supination. Pronation is when your arch collapses slightly, to make your foot more flexible and able to absorb irregularities in the ground; this is supposed to happen right after your heel hits the ground. As your foot pronates, the leg rotates inward, which causes your knee to rotate in, which causes your thigh to rotate in, which causes you spine to flex forward. Supination is when your foot reforms the arch and makes your foot a rigid lever, to help you propel yourself; This is supposed to happen when you are pushing off with your toes to move forward. It is at this time that the entire process reverses itself, and your leg, knee, and thigh rotate outward and your spine extends backward. When these movements don’t occur, or more often, occur too much, is when problems arise. This can be due to many reasons, such as lack of movement between your foot bones (subluxation), muscle tightness, injury, inflammation, and so on.

Many people over pronate, due to incompetence of the intrinsic musculature of the lower kinetic chain, genetics, environmental factors or injuries. This means that their arch stays collapsed too long while in stance phase, and they remain pronated while trying to push off. As we discussed, during pronation the foot is a poor lever. This means you need to overwork to propel yourself forward. This can create arch pain, inflammation on the bottom of the foot (plantar fascitis), abnormal pressure on your foot bones (metatarsalgia), knee pain, hip pain and back pain.

Lets look at skiing. Skiing is a stance phase sport. While skiing, your foot stays relatively immobile in a ski or snowboard boot (i.e. it is not moving through a gait cycle). A footbed is designed to create a level surface for your feet and keep them in a neutral posture. It accomplishes this by “bringing the ground up to your foot.” They are generally custom designed to an individuals foot through many different methods. They work incredibly well (as long as the foot remains in a static posture) and many people extol the benefits and improvements in their respective sports when using these.

Orthotics are always custom made devices. They actually improve the mechanics of your foot (or give you mechanics you didn’t have before) and make it function more efficiently by altering the shape and function of the arch as the foot moves through various activities. They act like a footbed but have the added benefit of functioning while dynamic (i.e. moving) as well. This works as well or better than a footbed, and is usable in other sporting activities, such as Nordic skiing, snow shoeing, hiking, running, or biking. Many people use their orthotic in their everyday shoes, to help prevent some of the problems and symptoms they are experiencing. It should be emphasized that an orthotic IS NOT a substitution for competent musculature. We view them as an aid to assist the rehabilitation process; slowly pulling out correction as the biomechanical competence improves.  We like to call this “Orthotic Therapy”.

In summary, a footbed supports the foot in a neutral posture. It is great for activities where your foot is static or held in one position. An orthotic supports the foot in a neutral posture and improves the mechanical function of the foot. It can be used in static or dynamic activities. Remember to always consult with a professional who is well versed with the mechanics of the feet, ankles, knees, hips and back, since footbeds and orthotics have a profound effect on all these structures.

Orthotics and footbeds; they can be great assistive devices along the road to foot competence. And they can be great doorstops when you are done using them!

We are and remain..The Gait Guys.

Movement, can it make us better Humans ?

This will be the first blog post you read from us …  for 2014. Happy New year wishes to you all !

This is a rehash of some old stuff, and some new, it seemed to bring together many good points and thoughts of our work this year. We hope you agree.

We have an amazing video for you today, a testament to how amazing the human frame is and how amazing movement can be.  But first … . it has been an amazing year for both of us here at The Gait Guys. Through this year, we have bridged further chasms. Our podcasts went into high gear and we were blessed to know our voices spanned the miles into 70 countries. The National Shoe Fit Certification Program went into overdrive and sales were beyond our expectations. We blogged 2-3 times a week and tried to launch a weekly podcast for another method to reach the world.  We added some new videos and have made plans for more. We have finally finished the Foot and Gait Retraining DVD itinerary and now just need studio time to record, it looks like it could be 2-3 DVD project.  We also made many new friends while learning much on our own end in our relentless research and readings. We appreciate every one of you who has followed us, and we thank you for your friendship.

As we find ourselves here at the end of another year, it is normal to look back and see our path to growth but to look forward to plan for ways to further develop our growth.  Many of you who read our blog are runners, but many of you are in one way or another involved with a sport or activity that incorporates running and gait. Hey, we all walk !  Even in the video above the dancers are seen running and walking. What we mean is that many of you are coaches or trainers or movement experts who develop those who run or move in one way or another in various sports, but many of you are also in the medical field helping those to run and move to get out of pain or improve performance.  And still yet we have discovered that some of you are in the fields of bodywork such as yoga, pilates, dance, martial arts and movement therapies.  It is perhaps these fields that we at The Gait Guys are least experienced at (but are learning) and like many others we find ourselves drawn to that which we are unaware and wish to know more in the hope that it will expand and improve that which we do regularly.  For many of you that is also likely the case.  For example, since a number of you are runners we would bet to say that you have taken up yoga or pilates or cross training to improve your running and to reduce or manage injuries or limitations in your body. But why stop there ? So, here today, we will try to slowly bring you full circle into other fields of advanced movement. As you can see in this modern dance video above the grace, skill, endurance, strength, flexibility and awareness are amazing and beautiful.  Wouldn’t you like to see them in a sporting event ? Wouldn’t you like to see them run ? Aren’t you at least curious ? Their movements are so effortless. Are yours in your chosen sport ? How would they be at soccer for example ? How would they be at gymnastics ? Martial arts ? Do you know that some of the greatest martial artists were first dancers ? Did you know that Bruce Lee was the Cha Cha Dance Champion of Hong Kong ? He is only one of many. Dance, martial arts, gymnastics …  all some of the most complex body movements that exist. And none of them are simple, some taking decades to master, if that, but most of which none of us can do. In 2014 we will continue to expand your horizons of these advanced movement practices as our horizons expand. We plan to return to dance again to advance our thinking of foot and body movements, incorporating many aspects into our treatment and exercise regimens, and now that we have a year of jiu jitsu under our belts it is time to consider add the sport of Parkour. Why not add this knowledge to your repertoire ?  Many of our athletes do not even know that much of their exercise homework is from basic dance principles, until we tell them at the end of a session.  There is a reason why some of the best athletes in the NBA, NFL and other sports have turned to almost secret study of dance and martial arts because there is huge value in it.  Look at any gymnast, martial artist or dancer. Look at their body, their posture, their grace.  It is as if their bodies know something that ours do not.  And so, in 2014 The Gait Guys will dive even deeper into these professions to learn principles and bring them back to you. After all, everything we do is about movement. Movement is after all what keeps the brain alive and learning. 

Below are excerpts from a great article from Kimerer Lamothe, PhD. She wrote a wonderful article in Psychology Today a few years ago  on her experience with McDougall’s book “Born to Run” and how she translated it into something more.  At some point, take the time to read her whole article.  But do not cut yourself short now, you only have a little more reading below, take the next 2 minutes, it might change something in your life.

We leave you now with our 2013 gratitude for this great growing brethren and community that is unfolding here at The Gait Guys. We have great plans for 2014 so stay with us, grow with us, and continue to learn and improve your own body and those that you work with.  Again, read Kimerer’s most excellent excerpts below, for now, and watch the amazing body demonstrations in the video above. It will be worth it.

_____________________

Can Running Make us Better Humans ?….. excerpts from the artcle by Kimerer LaMothe.

http://www.psychologytoday.com/blog/what-body-knows/201109/can-running-make-us-better-humans

“The Tarahumara are not only Running People, they are also Dancing People. Like other people who practice endurance running, such as the Kalahari Kung, dancing occupies a central place in Tarahumara culture. Or at least, it has. The Tarahumara dance to pray, to celebrate life passages, to mark seasonal and religious events. They dance outside where Father God and Mother Moon can see, in patterns consisting of steps and shuffles, taps and hops, performed in a line or a circle with others. And they dance the night before a long running race, while the native corn beer, or tesguino flows.

While McDougall notes the irony of “partying” the night before a race, he doesn’t ask the question: might the dancing actually serve the running? Might it be that the Tarahumara dance in order to run—to ensure the success of their run—for themselves and for the community?

At the very least, the fact that the Tarahumara dance when and how they do is evidence that they live in a world where bodily movement matters. They believe that how they move their bodies matters to who they are and to how life happens. They have survived as a people by adapting their traditional method of endurance hunting (running animals to exhaustion) to the challenges of fleeing Spanish invaders, accessing inaccessible wilderness, and staying in touch with one another while scattered throughout its canyons. As McDougall notes, they have kept alive an ancient genetic human heritage: to love running is to love life, for running enables life.

Yet McDougall is also clear: even the Tarahumara are not born knowing how to run. Like all humans, they must learn. Even though human bodies are designed to flourish when subject to the stresses of long distance loping, we still need to learn how to coordinate our limbs to allow that growth to happen. We must learn to run with head up, carriage straight, and toes reaching for the ground. We must land softly and roll inwardly, before snapping our heels behind us. We must learn to glide—easy, light, smooth—uphill and down, breathing through it all. How do we learn?

How do we learn to run? We learn by paying attention to other people, and taking note of the movements they are making. We learn by cultivating a sensory awareness of our own movements, noting the pain and pleasure they produce, and finding ways to adjust. We learn by creating and becoming patterns of movement that release our energy boldly and efficiently across space. We learn, in a word, by dancing.

While dancing, people open up their sensory selves and play with movement possibilities. The rhythm marks a time and space of exploration. Moving with another heightens the energy available for it. Learning and repeating sequences of steps exercises a human’s most fundamental creativity, operating at a sensory level, that enables us to learn to make any movement in any realm of endeavor with precision and grace. Even the movements of love. Dancing, people affirm for themselves and with each other that movement matters.

In this sense, dancing before the night of a running race makes perfect sense. Moving in time with one another, stepping and stretching in proximity to one another, the Tarahumara would affirm what is true for them: they learn from one another how to run.  They learn to run for one another. They run with one another. And when they race, they give each other the chance to learn how to be the best that they each can be, for the good of all.

It may be that the dancing is what gives the running its meaning, and makes it matter.

Yet the link with dance suggests another response as well. In order for running to emerge in human practice as something we are born to do, we need a culture that values movement—that is, we need a general appreciation that and how the bodily movements we make matter. It is an appreciation that our modern western culture lacks. 

Those of us raised in the modern west grow up in human-built worlds. We wake up in static boxes, packed with still, stale air, largely impervious to wind and rain and light. We pride ourselves at being able to sit while others move food, fuel, clothing, and other goods for us. We train ourselves not to move, not to notice movement, and not to want to move. We are so good at recreating the movement patterns we perceive that we grow as stationary as the walls around us (or take drugs to help us).

Yet we are desperate for movement, and seek to calm our agitated senses by turning on the TV, checking email, or twisting the radio dial to get movement in a frame, on demand. It isn’t enough. Without the sensory stimulation provided by the experiences of moving with other people in the infinite motility of the natural world, we lose touch with the movement of our own bodily selves. We forget that we are born to dance and run and run and dance.

The movements that we make make us. We feel the results. Riddled with injury and illness, paralyzed by fears, and dizzy with exhaustion, our bodily selves call us to remember that where, how, and with whom we move matters. We need to remember that how we move our bodies matters to the thoughts we think, the feelings we feel, the futures we can imagine, and the relationships we can create with ourselves, one another, and the earth.

Without this consciousness, we won’t be able to appreciate what the Tarahumara know: that the dancing and the running go hand in hand as mutually enabling expressions of a worldview in which movement matters.”

Thanks for a great article Kimerer. (entire article here)http://www.psychologytoday.com/blog/what-body-knows/201109/can-running-make-us-better-humans

*oh, and want a little more of these performers in the video, check this out……. it will move you.

http://youtu.be/CvQBUccxBr4

Wishing a Happy New Year to you all, from our hearts……. Shawn and Ivo

The Gait Guys

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On the subject of manual muscle work…There is more to it than meets the eye….

Following with our last few posts, here is an article that may seem verbose, but has interesting implications for practitioners who do manual muscle work with their clients. We would invite you to work your way through the entire article, a little at a time, to fully grasp it’s implications.

Plowing through the neurophysiology, here is a synopsis for you:

Tactile and muscle afferent (or sensory) information travels into the dorsal (or posterior) part of the spinal cord called the “dorsal horn”. This “dorsal horn” is divided into 4 layers; 2 superficial and 2 deep. The superficial layers get their info from the A delta and C fibers (cold, warm, light touch and pain) and the deeper layers get their info from the A alpha and A beta fibers (ie: joint, skin and muscle mechanoreceptors).

So what you may say.

The superficial layers are involved with pain and tissue damage modulation, both at the spinal cord level and from descending inhibition from the brain. The deeper layers are involved with apprising the central nervous system about information relating directly to movement (of the skin, joints and muscles).

Information in this deeper layer is much more specific that that entering the more superficial layers. This happens because of 3 reasons:

  1. there are more one to one connections of neurons (30% as opposed to 10%) with the information distributed to many pathways in the CNS, instead of just a dedicated few in the more superficial layers
  2. the connections in the deeper layers are largely unidirectional and 69% are inhibitory connections (ie they modulate output, rather than input)
  3. the connections in the deeper layers use both GABA and Glycine as neurotransmitters (Glycine is a more specific neurotransmitter).

Ok, this is getting long and complex, tell me something useful...

This supports that much of what we do when we do manual therapy on a patient or client is we stimulate inhibitory neurons or interneurons which can either (directly or indirectly)

  1. inhibit a muscle
  2. excite a muscle because we inhibited the inhibitory neuron or interneuron acting on it (you see, 2 negatives can be positive)

So, much of what we do is inhibit muscle function, even though the muscle may be testing stronger. Are we inhibiting the antagonist and thus strengthening the agonist? Are we removing the inhibition of the agonist by inhibiting the inhibitory action on it? Whichever it may be, keep in mind we are probably modulating inhibition, rather than creating excitation.

Semantics? Maybe…But we constantly talk about being specific for a fix, not just cover up the compensation. Is it easier to keep filling up the tire (facilitating) or patching the hole (inhibiting). It’s your call

The Gait Guys. Telling it like it is and shedding light on complex ideas, so you can be all you can be.

link: http://jn.physiology.org/content/99/3/1051

Muscle Activation Concerns
We are concerned about some things that are showing up in our clinics lately. Strange injury patterns we have not seen before. We know you are all very busy, because you are the best what you do, but we hope that by sharin…

Muscle Activation Concerns

We are concerned about some things that are showing up in our clinics lately. Strange injury patterns we have not seen before. We know you are all very busy, because you are the best what you do, but we hope that by sharing these 2 articles with you we can all further raise this team of practitioners, coaches, physical therapists, trainers, pilates and yoga instructors, surgeons etc and work even more effectively as a team.  
This issue is about muscle activation or facilitation.
As you are all learning, this game is more than just turning muscles on, and there are risks to turning something on when the central nervous system has decided it is not safe to turn something on. We are all treating people who are slouched over all day either as students or at desk jobs and thus everyone (seeing as they are all dropped into hip, knee and cervical, thoracic and lumbar spine flexion) will have some degree of inhibited glutes (and thus reciprocal neuro-protective hip flexor tightness) that appear to need activated when the truth is that they need more central extension facillitation. Activating the glutes when there is a central flexion inhibition driver overrides the nervous system’s protective inhibition response. Hence the near-epidemic of hamstring and hip flexor/groin/labrum tear problems we are seeing !   There are logical reasons why something is not activated. Sometimes it is a 
1. muscle skill pattern (large diameter nerve, all muscle fiber diameters), 
2. sometimes it is an endurance problem (large diameter nerve, small muscle fiber diameter),
3.  sometimes it is a strength problem (largest diameter nerve, largest diameter muscle fibers). 
Knowing a problem is driven by 2 or 3 will tell the practitioner that activation will not solve the problem and that activation can force a compensation pattern that can lead to a future injury. Also, sometimes it has nothing to do with the muscles motor nerve activity, it may in fact be about the reciprocal inhibitory neurosensory input (see our post on reciprocal inhibition here). 
Hence we wanted to share 2 articles we wrote. These articles were spurred by the magnified influx in the last year of injuries that appear compensatory, meaning they seem to have occurred because alternative compensatory motor patterns were encouraged where there appear to be clear signs that they should not have been encouraged.  In other words, sorry to say this, people with a weaker understanding of how and why the nervous system works are using muscular activation as a tool when it is the wrong tool. When you are pounding a nail, using a screwdriver won’t get you good results, and might get you the wrong results. But, if all you have is a screwdriver … . .
The blog posts are below. We strongly believe that many of these injuries we are seeing are not necessary. We always ask ourselves when a person who we have been working on says to us “honest doc, I really did not do anything, I was just running comfortably and the hamstring grabbed at me for no apparent reason.”  These stories always make us look in wards and ask “is this injury my fault ?” “Did this occur because I was activating the wrong muscles and wrong patterns thus forcing them into a less worth protective pattern because I thought I knew better than their nervous system did ?” When we want to learn we judge ourselves and our actions  harshly, for we know we make mistakes and we know we are still students. We know that if it appears simple, it might be a good time to step back and think it through a little more. 
Don’t just be an muscle “activator”, be a thinker who occasionally activates when it is appropriate.  The nervous system knows better than you do, accept this and try to figure out why it is shutting things down.
Shawn and Ivo

image from : http://www.emeraldinsight.com/books.htm?chapterid=1775219&show=html

Podcast 49: Winter Running Biomechanical Problems

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-49-winter-running-biomechanical-problems

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience 

1. Skulpt Aim: World’s First Device to Measure Muscle Fitness with One Touch | Indiegogo

http://www.indiegogo.com/projects/skulpt-aim-world-s-first-device-to-measure-muscle-fitness-with-one-touch/

3. Something to consider when it comes to injuries, whether they are closed injuries and certainly when they are open injuries !
 
Bacteria directly activate sensory nerves
http://www.bodyinmind.org/bacteria-directly-activate-sensory-nerves/
Gait Talk:
4. walking on ice vs on slipper hardwood floors with socks.
what are the gait changes that need to be adapted
are their neurologic effects ?
5. The Pros and Cons of Stride Variability
Our Disclaimer !  
6. From a blog reader:
Hi Gait Guys - amazing wealth of info you’ve provided! I’ve been suffering from severe foot pain (peroneal tendonitis and general top/side foot pain) for about a year now which has turned me from very active to completely sedentary since I can hardly walk. My ortho gave up on me after 9 months of treatment incl. countless oral and injected steroids and 2 months in a boot. Then this morning I found your site - and the “The Gaits of Hell” video. That’s my walk!! Is it really all in my back?
7. From a blog reader
Question: when my feet point straight my knees point outward from my body. I’ve heard it called external femoral torsion …
8 . Effects of Nonslip Socks on the Gait Patterns of Older People When Walking on a Slippery Surface
9 . National Shoe Fit Program
10. Running Form: Recognizing Patterns and Posture
http://www.engagingmuscles.com/2013/12/03/running-form-recognizing-patterns-and-posture/
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And what have we here?

The above is a pedograph, a simple, effective pressure map of the foot as someone is walking across an inked grid. For more info on pedographs, click here.

Did you note the increased ink present under the great toe bilaterally? What could be causing this? If you look carefully, you will note that it is at the base of the proximal phalynx of the great toe. This could be none other than the tendon of the flexor hallucis brevis!

This bad boy arises from the medial part of the under surface of the cuoid and the adjacent 3rd cunieform, with a small slip from the tendon of the tibialis posterior. As it travels forward it splits into two parts, which are inserted into the medial and lateral sides of the base of the proximal phalanyx of the great toe. There is a sesamoid bone present in each tendon, which offers the FHB a mechanical advantage when flexing the toe.  The medial portion is blends with the abductor hallucis and the lateral portion blends with the adductor hallucis.

Had the increased printing on the pedograph been more distal, it most likely would have been due to increased action of the flexor hallucis longus.   Had it been more proximal (under the head of the 1st metatarsal) it would have been due to the peroneus longus.

Cool, eh?

Reading pedographs and making you a sharper clinician/coach/trainer/sales person is just one of the many skills we try to teach here on the blog. Keep up the great work!

The Gait Guys

“And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ‘till his puz…

“And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ‘till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store? What if Christmas, perhaps, means a little bit more?”

Wishing you a safe and blessed holiday! Keep your glutes engaged and your toes up!

The Gait Guys

Usain… Again!!! How good are your powers of observation?

Take a look at this video again. Yes, we have shown it many times before. It is from a 2001 race in Monaco.

These are all incredible athletes. What can we note about the fastest of the fast?

  • Most of them have excellent hip extension (ok, the gent immediately to Usain’s right does not appear to be optimal)
  • the fastest of the pack have a upright head posture with the neck neutral or in slight extension (gents in lanes 1, 3 and 6; notice the head forward posture of the others)
  • minimal heel rebound (see our last post on this here)
  • minimal torso motion (note the increased torso motion  with arm swing of the gents in lanes 1, 3, 4 and 5)
  • symmetrical hip flexion, with the thigh parallel or nearly parallel to the ground in float phase
  • what else?

Watch it a few more times. It took us a while too…

Really, go watch it again…

Did you see it?

Watch the vertical oscillation of the runners. At this level (or any level for that matter), outside of improving biomechanics and neuromechanics, there are really only a few things you can do to run faster. One is to have a faster cadence and another is to have a longer stride length. You can control both, but if not done concurrently, one gets better at the expense of the other.

If your cadence is slower and you try and increase stride length, you increase your vertical oscillation (ie: how much you bounce up and down). Note the handrail at the far side of the track. It makes a convenient marker for vertical oscillation. Watch this bar and watch the video again. Usain and the gent in lane 6 (Nesta Carter) have little vertical oscillation compared to the rest of the pack. Note also the close finish. difficult to say if Usain’s knee or Carters foot crossed 1st. Usiain’s time was 9.88 and Nesta’s 9.90.

Decreased cadence = Increased vertical oscillation = Less horizontal motion = Slower speeds

How about watching this video a few more times and telling us what else is up?

The Gait Guys. We are trying to help you improve your powers of observation while stretching your mind. Are we succeeding? We hope so!

Ivo and Shawn

Podcast 48: Running Tech, Cadence and Running Shoes

Podcast 48 is live !  Topics: new gait and running technologies, general gait and running talk, generation slow-poke, cadence and barefoot, mixing up your running shoes, a case of hallux rigidus and more !  Join us for another podcast here on The Gait Guys !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-48-running-tech-cadence-and-running-shoes

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience piece
 
1. The Sproutling: Why A Fitbit For Babies Might Be Brilliant
http://www.fastcodesign.com/3019806/the-sproutling-why-a-fitbit-for-babies-might-be-brilliant?partner=rss

2.Coming Soon: Workout Gear That Monitors Your Muscles
 
3. Micromovements hold hidden information about severity of autism
http://www.sciencedaily.com/releases/2013/12/131202171813.htm
4 Gait Factoid:
Q: Why do the two of us focus on gait so much ?  
A: Because it is such a deeply primary motor pattern that it is all encompassing.  
5. in the media this week:
Generation slowpoke? Kids don’t run as fast as parents once did, study finds - TODAY.com
http://www.today.com/moms/generation-slowpoke-kids-dont-run-fast-parents-once-did-study-2D11603599
6. CADENCE and BAREFOOT
7. In the media:
Can mixing up the running shoes prevent overuse running injury? | Running Research Junkie
 
9. From a Blog reader:
Hello the gait guys. I have over pronated rigid cavus along with hallux rigidus on my feet (also had one failed surgery for hallux rigidus on right foot). Having really hard time to be on my feet as well as find shoes and use orthotics. Due to the rigidity of my feet orthotics I’’ve been given create pain I can’t bear and mostly push medial side of my feet. Also without orthotics it is not much better - getting constant pain in my feet and knees. What would be your advise in my situation?Thanks
Disclaimer 
10. From a blog reader
Question: when my feet point straight my knees point outward from my body. I’ve heard it called external femoral torsion. Is this correct? Also is there any type of PT/stretching I can do to correct this? Would love to get things straightened out (no pun intended).
11 . National Shoe Fit Program

Ankle Dorsiflexion: Even in sprinters who land on the forefoot often heel strike, a retrograde strike if you will.

Many people think of heel strike followed by midfoot/tripod contact phase followed by ankle dorsiflexion, aka ankle rocker.  Heel strike is normal in the walking gait cycle. In some runners, depending on foot type, strength, flexibilty and several other factors, heel strike may be considered normal and may be essential for normal injury free mechanics. However, in recent years we tend to see the media and research investigate a midfoot or forefoot strike pattern. If you have been here with us on TGG for a year or 2-3 you will know we are big advocates of a midfoot strike pattern for several reasons which we will not go into again in this article. (Feel free to SEARCH our blog for MIDFOOT strike articles).  

However, one rarely sees anyone or any source talking about the retrograde heel contact when forefoot strike patterns are used.  Here, in this video, you can see several of these top level athletes who are trying to go forward at top end speed, but who are tapping the heel down on many loading responses. This can be thought of as a retrograde movement and could in a biomechanical way of thinking be considered non-productive. In other words, they are trying to move forward and yet the heel is touching down which is a backwards movement. This point can be argued but that is not the point of this article. The point that we are trying to make is that in order to drop the heel down, and especially if the heel touches, that the runner had better have sufficient ankle rocker/dorsifleixon otherwise the arch may be asked to collapse via excessive pronation (to perform the heel tap) which will drive an internal spin movement when the leg is supposed to be externally rotating to a rigid supinated foot for propulsive toe off. This negative scenario is a huge power leak for a sprinter, or any runner for that matter when they are ramping up speed.  

So, why does this happen ?  Well, for some it can help to load the posterior mechanism, the gastrocsoleus-achilles complex for conservation and power conversion.  It also enables more hip extension and thus more gluteal function. Longer stride means more efficient and greater arm swing which is a huge accessory power source for a sprinter. This also lengthens the stride, they feed off of each other. There are many benefits, if you have sufficient ankle rocker range in the ankle to begin with.  In some runners who do not have the requisite ankle rocker range, you may often see the increased foot progression angle and external limb spin and/or the dreaded adductor twist of the heel (aka  abductory twist of the foot).  These are strategies to get more hip extension and more gluteal function without finding it via the ankle dorsiflexion, where you want to see it.  Remember, the body is a brilliant compensatory and substituter. If the body cannot find a range at one joint it will find it at the next proximal or distal joint. And when that loss is at the ankle, motor patterns options dictate you either find it at foot pronation or hip extension.

Maybe, just maybe we should have called this blog article “Can you hold the foot tripod all the way through the stance phase, even through retrograde heel touch down ? If you cannot, trouble could be on the horizon. ”  But that is a really dumb title.  

Shawn and Ivo

the gait guys

Making a list and checking it twice…
So you or someone you are treating/coaching/ rehabbing, etc has muscle weakness, either perceived by them or noted by you, by observation or muscle testing. Have you stopped to think what might be causing the wea…

Making a list and checking it twice…

So you or someone you are treating/coaching/ rehabbing, etc has muscle weakness, either perceived by them or noted by you, by observation or muscle testing. Have you stopped to think what might be causing the weakness?

Cross sectional area is directly proportional to strength. With strength, we are talking predominantly about Type II muscle (remember, Type I is predominantly endurance muscle, due to differing histological structure).  Type II muscle fibers are larger, have fewer capillaries, less myoglobin, fewer mitochiondra . They obtain most of their energy by anaerobic glycolysis, rather than aerobic respiration  (ie the Krebs cycle).  All muscles are made of a mixture of Type I and Type II fibers, but most muscles tend to have a predominance of one over the other. Here we are referring to strength.

There are many causes of muscle weakness. Here are a few:

  • Injury to the muscle
  • Injury to the joint the muscle crosses
  • Stretch weakness
  • Tight weakness
  • Neurogenic weakness
  • Myopathic weakness
  • Reflexogenic weakness
  • And the list goes on…

The 1st one on the list is an easy one to understand. If you break the machine, it doesn’t work. Torn contractile proteins with leaky sarcoplasmic reticulum (calcium reservoirs) do not allow for efficient contractions.

The second on the list is a bit more complex.

We remember that that the joint capsules are blessed with four types of mechanoreceptors, aptly named Type I, II, III, and IV, which when stimulated physically, chemically, or thermally apprise the nervous system of the forces acting on that joint as well as its position in space. For a great video review of mechanoreceptors, click here

Joint pathology or inflammation will often cause distention of its capsule. The effect of the resulting joint effusion on the actions of the muscles crossing that joint have been examined extensively in the literature. Let’s look at one of the studies and its implications.

Reflex Actions of Knee Joint Afferents During Contraction of the Human Quadriceps

Iles JF, Stokes M, Young A: Clinical Physiology (10) 1990: 489-500

In this paper, the authors infuse hypotonic saline into the knees of eight asymptomatic individuals (including one of the authors) using a 16 gauge needle (ouch!) and studied its effects on the H reflexes and muscle recruitment. An H reflex is like performing a tendon jerk reflex (the involuntary contraction you would check with a neurological hammer) using an electrical stimulus. The onset time (also called the latency) and its amplitude are recorded. Muscle recruitment is the voluntary contraction of that muscle, measured with electromyography (EMG) by having an electrode either over (surface EMG) or within (needle EMG) the muscle and examining how hard the muscle is working based on the amplitude and frequency of the response.

First of all, no one in the study experienced any pain (hmmm, not sure about that) , only the sensation of pressure in their knees (which was considered activation of only the proprioceptors of the joint). The authors found that any pressure increase within the joint capsule depressed the H reflex and inhibited the action of the quadriceps. They hypothesize that this may contribute to pathological weakness after joint injury.

So how does all this apply to us?

As we all know, lots of patients have joint dysfunction. Joint dysfunction leads to cartilage irritation, which leads to joint effusion. This will inhibit the muscles that cross the joint. This causes the person to become unable to stabilize that joint and develop a compensation pattern. Next the stress is transferred to the connective tissue structures surrounding the joint which, if the force is sufficient, will fail. Now we have a sprain and some of the protective reflexes can take over. Abnormal forces can now be translated to the cartilage. This, if it goes on long enough,  can perpetuate degeneration, which causes further joint dysfunction. The cycle repeats and if someone doesn’t intervene and control the effects of inflammation, restore normal joint motion and rehabilitate the surrounding musculature, the patient’s condition will continue its downward spiral, becoming another statistic contributing to the tremendous economic and physical costs of an injury.

And that, my friends, is one mechanism as to how joint effusion disturbs the homeostasis of the musculature surrounding a joint.

In future posts, we will examine other causes of muscle weakness. For now, make a list of possible causes before assuming it is just injured or “turned off”. Compensations happen for a reason, and if you remove someone’s compensation pattern, you had better make sure you have another one up your sleeve and that their system is ready for a change.

The Gait Guys. Giving you the tools so you can be better. Period. 

Podcast 47: The Thigh Gap & Medial Tibial Stress Syndrome

Podcast 47 is live !

Topics: Lots of cool stuff for your ears and brains today. Don’t miss this show on Allen’s Rule Part 2, ankle biosensors, Parkinson’s syndrome gait disorder, Medial Tibial Stress Syndrome, The Thigh Gap disorder, and the ever confusing and much debated Abductory Heel Twist in walking and in runners. Don’t miss this show !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-47-the-thigh-gap-medial-tibial-stress-syndrome

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience piece
1. Update on Allen’s Rule blog post:
2. Could a simple ankle sensor help with parkinsons symptoms ?
3. Probiotics Boost Running Performance in Heat
5 Gait Factoid:  the foot abductory twist
6.  Note from melissa on her 9 month leg pain.
Disclaimer 
7 . National Shoe Fit Program
8 . medial tibial stress syndrome
9. from a blog reader:
The thigh-gap obsession is not new but it’s the most extreme body fixation yet